Outcome in the small for gestational age neonates in their early neonatal period in relation with the cord blood nucleated RBC’s


  • T. Prashanth Reddy Department of Pediatrics, Navodaya Medical College and Hospital, Raichur, Karnataka, India
  • Ramesh Chittam Department of Pediatrics, Navodaya Medical College and Hospital, Raichur, Karnataka, India
  • Sravan Kumar T. Department of Pediatrics, Navodaya Medical College and Hospital, Raichur, Karnataka, India
  • Sindhura K. Department of Pediatrics, Navodaya Medical College and Hospital, Raichur, Karnataka, India
  • Sanjeev Chetty Department of Pediatrics, Navodaya Medical College and Hospital, Raichur, Karnataka, India






Background: NRBCs are physiologically found only in the peripheral blood of the fetus and neonates. Under all other conditions, NRBC is an indicator of pathology, either increase in erythroid activity or damage to the bone marrow has been suggested that the presence of elevated NRBC in the umbilical cord blood is a sign of fetal hypoxia.1-12. Elevated NRBC is a sign of fetal hypoxia in newborns of mothers with preeclampsia even with well controlled hypertension.

Methods: The study period is 1 year from November 2015 to October 2016 on Term SGA babies delivered in Navodaya Medical College Hospital and Research Centre. Inclusion criteria all term SGA and healthy term AGA Newborns. Exclusion criteria were mothers with the following condition: maternal diabetes mellitus, hypertension, preeclampsia, chorioamnionitis and babies with the following conditions meconium stained amniotic fluid, congenital anomalies, twin-to-twin transfusion, severe anemia, cyanotic heart disease.

Results: The mean gestational age among control and study group was 18.96 and 19.08 respectively. Low APGAR score (≤5) was seen in 3 cases in the study group. No newborn in control group had low APGAR. Out of 50 babies included in this study,24 babies were delivered by LSCS and 26 babies by normal vaginal delivery. the NRBC count was found to be significantly higher in the SGA babies group as compared to the AGA group and this was statistically significant [p,0.005].

Conclusions: My study showed that NRBC count was higher in SGA babies than term AGA babies but there was no correlation of NRBC count with the outcome in SGA babies.


Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed. 2001;84(3):F211-5.

D'Souza SW, Black P, MacFarlane T, Jennison RF, Richards B. Haematological values in cord blood in relation to fetal hypoxia. Br J Obstet Gynecol. 1981;88(2):129-32.

Naeye RL, Localio AR. Determining the time before birth when ischemia and hypoxemia initiated cerebral palsy. Obstet Gynecol. 1995;86(5):713-9.

Soothill PW, Nicolaides KH, Campbell S. Prenatal asphyxia, hyperlacticaemia, hypoglycaemia, and erythroblastosis in growth retarded fetuses. Br Med J (Clin Res Ed). 1987;294(6579):1051-3

Thilaganathan B, Athanasiou S, Ozmen S, Creighton S, Watson NR, Nicolaides KH. Umbilical cord blood erythroblast count as an index of intrauterine hypoxia. Arch Dis Child Fetal Neonatal Ed. 1994;70(3):F192-4.

Korst LM, Phelan JP, Ahn MO, Martin GI. Nucleated red blood cells: an update on the marker for fetal asphyxia. Am J Obstet Gynecol. 1996;175(4 Pt 1):843-6.

Boskabadi H, Maamouri G, Sadeghian MH, Ghayour-Mobarhan M, Heidarzade M, Shakeri MT, et al. Early diagnosis of perinatal asphyxia by nucleated red blood cell count: a case-control study. Arch Iran Med. 2010;13(4):275-81.

Gea Y, Araujo O, Silva LV. Clinical value of lactate measurement and nucleated red blood cell counts in the placental segment of the umbilical vein of premature newborns for diagnosis of hypoxia-ischemia. J Pediatr (Rio J). 2007;83(2):186-90

Hanlon-Lundberg KM, Kirby RS. Nucleated red blood cells as a marker of acidemia in term neonates. Am J Obstet Gynecol. 1999;181(1):196-201.

Low JA. Intrapartum fetal asphyxia: definition, diagnosis, and classification. Am J Obstet Gynecol. 1997;176(5):957-9.

Papa D, Jyotsna GP, Ashok BB. Cord blood nucleated red blood cell count -a marker of fetal asphyxia. J Obstet Gynecol India. 2008;58(1):45-8.

Phelan JP, Korst LM, Ahn MO, Martin GI. Neonatal nucleated red blood cell and lymphocyte counts in fetal brain injury. Obstet Gynecol. 1998;91(4):485-9.

Buonocore G, Perrone S, Gioia D, Gatti MG, Massafra C, Agosta R, et al. Nucleated red blood cell count at birth as an index of perinatal brain damage. Am J Obstet Gynecol. 1999;181(6):1500-5.

Blackwell SC, Refuerzo JS, Wolfe HM, Hassan SS, Berry SM, Sokol RJ et al. The relationship between nucleated red blood cell counts and early-onset neonatal seizures. Am J Obstet Gynecol. 2000;182(6):1452-7.

Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. Int J Gynecol Obstet. 2003;81(3):267-71.

Haiju Z, Suyuan H, Xiufang F, Lu Y, Sun R. The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy. J Perinat Med. 2008;36(3):240-7.

Green DW, Hendon B, Mimouni FB. Nucleated erythrocytes and intraventricular hemorrhage in preterm neonates. Pediatrics. 1995;96(3 Pt 1):475-8.

Silva AM, Smith RN, Lehmann CU, Johnson EA, Holcroft CJ, Graham EM. Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants. Obstet Gynecol. 2006;107(3):550-6.

Lubetzky R, Stolovitch C, Dollberg S, Mimouni FB, Salomon M, Mandel D. Nucleated red blood cells in preterm infants with retinopathy of prematurity. Pediatrics. 2005;116(5):e619-22.

Mandel D, Lubetzky R, Mimouni FB, Cohen S, Littner Y, Deutsch V et al. Nucleated red blood cells in preterm infants who have necrotizing enterocolitis. J Pediatr. 2004;144(5):653-5.

Minior VK, Bernstein PS, Divon MY. Nucleated red blood cells in growth-restricted fetuses: associations with short-term neonatal outcome. Fetal Diagn Ther. 2000;15:165-9.






Original Research Articles